0101-290 (SFD)CO
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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
eJtWVCd+/ {'"1, � t 0.443012
Date t 1 Signature of Contractor.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
•( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of,.Section 3700 of the Labor
Code, I shall forthwith comply with those provisions'.',
Date: - I.. Applicant s. f.-.fv v� {,q,
i:• �: {j»A"SJR \.J
Warning: Failure to secure Workers' Compensation .overage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property�for.,inspection purposes.
Signature (Owner/Agent),Date' 4, r110
.5555.... . r
BUILDING PERMIT PERMT#
DATE VALUATION LOT (1()1.-2S0TRACT
33
59 284.90-7
JOB SITE v '' a
APN
ADDRESS
79470 crraul.9
769-720-010
OWNER
CONTRACTOR / DESIGNER ENGINEER
6H 17My
4k 1 8keD Sows
1�1(t LAR CA. 925 11)
5 RArKRIDDE CA. 92806
(909)682-5352 0111A 51486
USE OF PERMIT
:3ii3 U. FlIkI LY D' `t:i.LWG
SKA, PLAN: IBR 10T-39 Pf!RMIT f)OkS t+OT tNC U1:3E
UCXK(fs,41AR!?O0D. DR!V AY -APPROACH, 1513`0 6''.1:AW CHECK "M
IZ,E.Oii•DMC'rXrT; K9At ISSU At•YCE OF SAME.PLAN TYPE
f;;l<3STOM C014STRUC'TION x'762.00 SF
F
P9I3Cf-ii'PA`1IO 391.06 SF
0ARAODCAUOR
GSTHESl'RUCTION FEZ 101.000.415.000 �1,D91.4A
PLAN G"HECK:;� 101.000-439-318 $t:3.',i.1?
NUECHA141CAi. FRE 1.01-000.421-000 233
$f)
FAX.0TRI CAL FFZ 101-000-420-000 $159
19
1'LUMBiNO FE. E 101.000.419-UOO $1 O),'75
STRONG MOTION FES-'R.EWD 101-000-241.000 $22
ps
O1"i.1fDTNO,FfIfl 107-00 0-423-000 3h0.00
223-00.0.443-342 3I'm
014
.t"XT §N PUBLIC LAC S.. id,i: E'101-000-255- 000 V j
n
WJI)-TOTAL L':C?lwlfM.1VL'GMi)W AND K" OTECK
5.3,76%. 313
x 1 k3 PFXI-:FIAJD Fri
s:'1 MOO
T011AE, YESUM(I MIA DUE NOW
RECEIPT
DATE
P6Y
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O. '
'Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final Z� �L( �i
BLOCKWALL APPROVALS
Final
Steel
POOLS • SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
`
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
.Gas Test +
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final p-
Utility Notice (Perm)
COMMENTS:
s CITY OF LA QUIlliRAev4
BUILDING & SAFETY DEP�TM N'T:z
777-7012 C4 41
INSPECTION REOUr& LIME U
- 777-715 R �
ownw SHEFFIELD HOMESI-
Contractor SHFFFEEI D HOME'S
Permit Numbor 0101-290
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-870 CITRUS
SFD-PLAN I BR LOT 59 -PERMIT DOES NOT INCLUDE
BLOC kWALLS/POO UDRIVEWAY APPROACH
TYPE OF INSPECTION
DATE INSP.
FOUNDATION 8 SETBACK
�l
FOOTING STEEL
MAIN GROUND SYSTEM
j
GROUND PLUMBING
PRE_-GUNITE
i
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB•-
U
JOISTS S GIRDERS
ELECTRICAL GROUND WORK
7 j
DO NO POUR CONCRETE UNTIL
ALL ABOVE HAS BEEN SIGNED i
ELECTRIC
i
_ROUGH
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING 8 VENT - A/C
FIREPLACE
ROOF
BOND BEAM
00,
O.K. TO WRAP
GROUT ❑ 4' 0 8'
IJ
FRAMING
p
INSULATION_..._
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR -a
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE 8 GATE
$EWER SEPTIC TANK J
FINALS
I
FINAL GAS TEST - O
HEATING - A/C l
HOUSE NUMBERS
JOB COMPLETED I Ii
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
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